An injection against cancer

By Drum Digital
02 September 2014

The HPV vaccine could help to eradicate cervical cancer but some parents feel it encourages teen sex. We asked experts for their views

Ask any mom if she’d have her 13-year-old daughter vaccinated against cancer, and she probably wouldn’t waste any time taking her to the nearest hospital.

But ask if she’d have her vaccinated against a sexually transmitted disease (STD) and the chances are good the answer will be no. Who after all wants to give such a young child the licence to have sex. This is the dilemma SA parents face with immunisation against the human papilloma virus (HPV), the most common cause of cancer of the cervix, increasingly encouraged by doctors and the state.

Moms and daughters are equally at risk, cervical cancer being the cancer that causes the most deaths among South African women. One in 26 women will develop it in their lifetime, according to the SA Society of Obstetricians and Gynaecologists.

But before you rush to the hospital, or launch afresh into a birds-and-bees lecture, read on so you can make an educated decision about HPV vaccination.

What is HPV?

HPV is a virus that affects human skin and mucus membranes, for example in your mouth, nose and sexual organs. The virus is transmitted during sexual contact, contact with body fluids and touching an open sore of an infected person.

Worldwide it’s the most common STD. There are a variety of human papilloma viruses, and they’re categorised according to how closely they’re linked to cervical cancer. Types 16 and 18 are most commonly associated with this cancer. While most women never show any symptoms, in some cases warts can occur. But if you’re not one of these cases, HPV can cause the cells in your cervix to mutate and turn into cancer cells.

Can vaccination help?

HPV is the direct cause of cervical cancer and the vaccine can protect you against it. The World Health Organisation (WHO) recommends females between the ages of nine and 25 are vaccinated. Professor Hennie Botha, head of the department of gynaecology at the University of Stellenbosch, says the earlier girls are vaccinated the better.

“It’s recommended that girls get immunised before they become sexually active. This improves their chances of being protected.”

In South Africa girls aged nine to 12 living in the poorest areas of the country will receive injections. Data released at the International Papillomavirus Conference in 2007 shows the injections are effective for women until age 45.

Vaccination is done with injections that boost your immune system’s resistance to HPV. A series of three injections are administered over a period of six months.

“The technology is still quite new so we can’t be absolutely sure but it should give protection for about nine years,” Professor Botha says.

Can I say no?

Although doctors recommend vaccination, it’s not mandatory for either you or your daughter to have the injection. Human rights groups in America have criticized the vaccinations and argue they encourage teens to be promiscuous, because “of course they’re protected now”.

Some mothers feel it’s unnecessary to vaccinate a 13-year-old against an STD because they don’t believe their children are sexually active. But experts believe this attitude is shortsighted.

“Discuss the issue first and tell your child what it’s about and what’s involved,” Professor Botha says.

Johannesburg-based psychologist Teboho Monyamane, who specialises in teen issues, says “it’s difficult for parents to consider the possibility that their teenage child could be sexually active”.

She says parents often tend to believe, erroneously, that conversations about sex and sexually transmitted diseases will spur their kids on to become sexually active.

“Parents want to keep their children innocent for as long as possible. But the thinking behind these discussions isn’t to encourage kids to have sex but rather to encourage them to minimise the dangers that come with being sexually active.”

Monyamane says for many parents it’s difficult – and shocking – to accept that scores of children are indeed sexually active from a young age. In her view HPV vaccination is unlikely to encourage a child to be sexually active.

“I think there are many other interpersonal and social factors that lead to a teenager becoming sexually active. It’s dangerous to ignore these factors.”

Dr Akashni Maharaj, a vocational guidance psychologist of Durban, says parents should stress to their children the vaccinations apply only to HPV, and therefore aren’t a green light for sex.

“Also make your child aware of the dangers of HIV and other sexually transmitted diseases.”

Maharaj says parents should keep in mind both the short- and long-term consequences. “Regardless of the circumstances there’s always a chance that a child might take sexual risks but here we also have a chance of longterm prevention of HPV, so parents should get to grips with what’s in the best interests of their children in the long run.”

The WHO has expressed its support for South Africa’s new vaccination programme in schools and Professor Botha emphasizes that putting a stop to HPV infection could potentially eradicate cervical cancer.

Can everyone be vaccinated?

Two injections are available in South Africa and both, Cervarix and Gardasil, have been approved by South Africa’s Medicines Control Council as safe and effective.

There are no life-threatening side effects in vaccinating against HPV. Most patients experience only a temporary redness and swelling where the injection was administered. Women with a history of being sensitive to vaccination or yeast shouldn’t use Gardasil as it contains yeast.

Inform your doctor of any medical conditions to make sure you’re eligible for vaccination.

And what about boys?

According to the Cancer Association of South Africa (Cansa) Gardasil is safe for use by males aged 11 to 21 and it can protect them against HPV. Men should consult their doctor to check if they need vaccination.

“The ideal would be eventually to vaccinate everyone in the country; this is the most effective way to prevent this cancer. Men who get the injections are protected against cancers caused by HPV [such as anal cancer] plus they protect their sexual partners,” Professor Botha explains.

Where to get the vaccine

Cervarix and Gardasil are schedule 4 medications and as such can be administered by a registered nurse, gynaecologist or general practitioner. You need a prescription to have it done at a pharmacy.

Medical aid

At this stage medical funds don’t pay for vaccination against HPV. “But we’re hoping that medical schemes will come on board. This vaccine doesn’t only prevent cervical cancer but can also eliminate most HPV-associated abnormalities and therefore makes a lot of sense,” head of Stellenbosch University’s gynaecological unit Professor  Hennie Botha says.

David Geral, a lawyer attached to Bowman Gilfillan, a law firm specialising in health care, says medical schemes are compelled only to cover medication and medical services appearing on the department of health’s prescribed list of minimum benefits.

“The minister of health will have to add it to the list first before medical funds will be legally obliged to pay for vaccination.”

But Geral believes the increasing popularity of the injections can promote competition between funds, resulting in some incorporating  vaccination into their schemes to attract clients.

The two vaccines available in SA

Gardasil - Gardasil protects users against HPV types 16 and 18 (which cause cervical cancer). It also protects against types six and 11, which cause warts. R770 an injection x 3 injections = R2 310 for vaccination.

Cervarix - Cervarix offers protection against HPV types 16 and 18. About R700 an injection x 3 injections = R2 100 for vaccination.

Professor Botha believes the cost of vaccinating should come down this year to about R500 an injection.

-          Mieke Vlok

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